P178: Scope of post-diagnostic dementia care by Japanese primary care clinics using team-based care models

Abstract

Objective:

Primary care clinics (PCCs) in Japan have acquired the capacity for screening and diagnosing dementia in its early stage. They face challenges in accommodating the complex care needs of people with early-stage dementia in collaboration with other healthcare providers in the community. The study aims were; 1) to classify team-based care models of PCCs for post-diagnostic care for people with early-stage dementia in Japan’s Community-based Integrative Care System and 2) to compare the scope of care in each model.

Methods:

We conducted a cross-sectional postal survey to certified Dementia Support Doctors working in PCCs in Tokyo. To classify team-based care models, the questionnaire asked about the members, roles, and collaboration of the community-wide care team for early-stage dementia in which participants’ PCCs were involved. We gathered information on care provision across seven domains that PCCs offered for people with early-stage dementia. Three-step latent class analysis was performed to classify models and analyze differences in the proportions of care provision in each domain. The Tokyo Metropolitan Institute for Geriatrics and Gerontology institutional review board approved the study.

Results:

From the 188 responses, PCCs’ team practices were categorized into three classes, which we named “co-managed,” carved-out,” and “stand-alone” models. While the first two ran an extended care team through in-person communication across facilities in the community, the last applied a minimal team approach with limited and indirect external interaction. The “co-managed” and “carved-out” models were distinguished by how team members shared decision-making responsibilities for patient care. Maximum likelihood estimation grouped 46.6%, 32.8%, and 20.6% of the PCCs into each model in the above order. The three models significantly differed in the proportions of care provision in five of seven domains. The proportions in each domain were the highest for the “co-managed” model (60.7-100%), followed by the “carved-out” (46.2- 98.2%) and “stand-alone” (25.7-88.6%) models.

Conclusion:

PCCs in Japan’s Community-based Integrative Care System formed three models of post- diagnostic support for people with early-stage dementia. Considering the application of the team approach and the breadth of care provision, either “co-managed” or “carved-out” models are recommended with available community resources in mind.